title: Carotid artery stenting according to the "tailored CAS" algorithm performed in the very elderly patients: the thirty day outcome.
abstract: OBJECTIVE
  To assess safety and efficacy of carotid artery stenting (CAS) according to "tailored-CAS" algorithm in the elderly (≥75 years) in relation to younger patients.
  
  
  BACKGROUND
  Although CAS has grown as an alternative to carotid endarterectomy the data on safety of CAS in the very elderly are inconsistent.
  
  
  METHODS
  1,139 patients with significant carotid stenosis underwent 1,252 CAS procedures in one high-volume center between years 2001-2011. CAS procedures were performed with lesion and patient dependent selection of neuroprotection type ("tailored-CAS"). There were 193 subjects ≥75-years-old (17%) and 946 <75-years-old. No major differences in atherosclerosis risk factors and comorbidities between groups were noted. In both groups the majority of patients were male (70.4% vs. 68.6%, P = NS) and half of the patients were symptomatic (50.2% vs. 55.2%, P = NS). Bilateral carotid stenosis was present in 25% of patients from CAS ≥75 group and 22% from CAS< 75 group, P = NS. Proximal neuroprotection devices use for high risk or symptomatic lesions accounted for 31% in CAS≥ 75 group and 32% in CAS<75 group, P = NS.
  
  
  RESULTS
  In symptomatic patients aged ≥75 years 30-day stroke and death rate was 7% versus 1.9% in symptomatic patients aged <75; P = 0.01 and vs. 1.8% in asymptomatic elderly, P = 0.09. No myocardial infarcts were noted.
  
  
  CONCLUSIONS
  Symptomatic elderly is a group of highest CAS risk and the use of "tailored CAS" algorithm does not equalize CAS risk in this patients' group. "Tailored CAS" remains a safe procedure for asymptomatic elderly as well as symptomatic and asymptomatic young patients.
authors.affiliation: Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II hospital, Krakow, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Dzierwa
authors.forename: Piotr
authors.initials: P
authors.lastname: Pieniazek
authors.forename: Lukasz
authors.initials: L
authors.lastname: Tekieli
authors.forename: Piotr
authors.initials: P
authors.lastname: Musialek
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Przewlocki
authors.forename: Anna
authors.initials: A
authors.lastname: Kablak-Ziembicka
authors.forename: Renata
authors.initials: R
authors.lastname: Kosobucka-Peszat
authors.forename: Roman
authors.initials: R
authors.lastname: Machnik
authors.forename: Mariusz
authors.initials: M
authors.lastname: Trystula
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015897:Comorbidity; D003661:Decision Support Techniques; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D018579:Patient Selection; D011044:Poland; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: carotid stenosis; cerebrovascular disease; stroke